Abstract
Kawasaki Disease (KD) is a systemic vasculitis with central nervous system (CNS) manifestations including irritability, cerebrospinal fluid pleocytosis and cerebral hypoperfusion. S-100, a dimeric protein present in glial cells, is elevated in patients with brain tumors and stroke and following cardiopulmonary bypass. The purpose of this study was to determine if serum S-100 protein levels are abnormally elevated in children with KD and to correlate these measurements with markers for systemic and CNS inflammation. We measured S-100 levels in 15 children with classical KD, mean age 3.0 years (range 7 months-6 years), at 3 intervals: presentation, 11-21 days from onset of disease and 22-63 days from onset. Elevated S-100 levels (>0.2μg/L) were found in 3/15 (20%) both at presentation, and at 11-21 days, and 4/15 (26.7%) at 22-63 days. The subjects were subdivided into Group I (n=8), at least 1 abnormal S-100 measurement and Group II (n=7), normal S-100 at all times. The groups were compared for, age, duration of fever, echocardiographic changes, irritability and systemic inflammatory markers at each time period. Clinical associations were made independent of knowledge of S-100 levels. There was no difference in clinical signs or echo findings between the groups following treatment. Patients in Group I were younger at presentation (1.7±1.4 yrs. vs. 4.1±1.9 yrs., p=0.05) and more irritable at diagnosis (71% vs. 13% p=0.04). Fever persisted longer in Group II (9.6±2.8 days) following treatment than in Group I (6.1±1.8 days, p=0.035). The findings show that S-100 protein was elevated in a number of patients with KD who were younger and more irritable at presentation. We speculate that inflammatory changes of the CNS can lead to increased levels of S-100 which can serve as a marker for CNS inflammation.
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Fulton, D., de Ferranti, S., Newburger, J. et al. S-100 Protein Levels in Children with Kawaski Disease: Correlation with Irritability. Pediatr Res 53, 177 (2003). https://doi.org/10.1203/00006450-200301000-00144
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DOI: https://doi.org/10.1203/00006450-200301000-00144